Baseline Vitals and SAMPLE History

Baseline Vital Signs and Baseline Vital Signs and SAMPLE HistorySAMPLE History


Given a patient care scenario and the proper Given a patient care scenario and the proper medical equipment in a clinical environment medical equipment in a clinical environment or field setting, or field setting,

Assess a baseline set of patient vital signs and Assess a baseline set of patient vital signs and obtain an accurate SAMPLE history obtain an accurate SAMPLE history

Describe the basic principles, sequence and Describe the basic principles, sequence and components of an accurate baseline set of components of an accurate baseline set of vital signsvital signs

Given a patient care scenario and the proper Given a patient care scenario and the proper medical equipment in a clinical environment medical equipment in a clinical environment or field setting, or field setting,

Assess a baseline set of patient vital signs and Assess a baseline set of patient vital signs and obtain an accurate SAMPLE history obtain an accurate SAMPLE history

Describe the basic principles, sequence and Describe the basic principles, sequence and components of an accurate baseline set of components of an accurate baseline set of vital signsvital signs

Terminal Learning ObjectiveTerminal Learning Objective

Demonstrate the proper technique(s) for Demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs obtaining a complete set of baseline vital signs and a concise patient history using the and a concise patient history using the acronym SAMPLE acronym SAMPLE

IAW Emergency Care and Transportation of IAW Emergency Care and Transportation of the Sick and Injured, 9the Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS). Academy of Orthopedic Surgeons (AAOS).

Demonstrate the proper technique(s) for Demonstrate the proper technique(s) for obtaining a complete set of baseline vital signs obtaining a complete set of baseline vital signs and a concise patient history using the and a concise patient history using the acronym SAMPLE acronym SAMPLE

IAW Emergency Care and Transportation of IAW Emergency Care and Transportation of the Sick and Injured, 9the Sick and Injured, 9thth Edition, American Edition, American Academy of Orthopedic Surgeons (AAOS). Academy of Orthopedic Surgeons (AAOS).


Given a patient with Eye, Ear, Nose, or Given a patient with Eye, Ear, Nose, or Throat complaints Throat complaints

Treat EENT Complaints Treat EENT Complaints

IAW A Guide to Physical Examination and IAW A Guide to Physical Examination and History Taking, Lippincott Co, Chapter 11 History Taking, Lippincott Co, Chapter 11

& Current Medical Diagnosis and & Current Medical Diagnosis and Treatment, Chapter 7 and 8.Treatment, Chapter 7 and 8.



Assessment is the most essential skill Assessment is the most essential skill EMT-Bs learn.EMT-Bs learn.

During assessment you During assessment you will: will:– Gather key informationGather key information

– Evaluate the patientEvaluate the patient

– Learn the historyLearn the history

– Learn about the patient’s overall healthLearn about the patient’s overall health

Assessment is the most essential skill Assessment is the most essential skill EMT-Bs learn.EMT-Bs learn.

During assessment you During assessment you will: will:– Gather key informationGather key information

– Evaluate the patientEvaluate the patient

– Learn the historyLearn the history

– Learn about the patient’s overall healthLearn about the patient’s overall health

Gathering Key Patient InformationGathering Key Patient Information

Obtain the patient’s name.Obtain the patient’s name.

Note the age, gender and Note the age, gender and

race.race.

Look for identification if the Look for identification if the

patient is unconscious.patient is unconscious.

Obtain the patient’s name.Obtain the patient’s name.

Note the age, gender and Note the age, gender and

race.race.

Look for identification if the Look for identification if the

patient is unconscious.patient is unconscious.

Baseline Vital SignsBaseline Vital Signs

During the assessment, the EMT-B uses During the assessment, the EMT-B uses many senses and a few basic medical many senses and a few basic medical instruments.instruments.

First set is known as First set is known as the baseline vitals.the baseline vitals.

Repeated vital signs Repeated vital signs are compared to the are compared to the baseline.baseline.

During the assessment, the EMT-B uses During the assessment, the EMT-B uses many senses and a few basic medical many senses and a few basic medical instruments.instruments.

First set is known as First set is known as the baseline vitals.the baseline vitals.

Repeated vital signs Repeated vital signs are compared to the are compared to the baseline.baseline.


Chief Complaint (Chief Complaint (CCCC); Mechanism of Injury ); Mechanism of Injury ((MOIMOI):):– Chief complaints are the major signs, Chief complaints are the major signs,

symptoms or events that caused the call or symptoms or events that caused the call or complaintcomplaint

– SymptomsSymptoms: what the patient tells you: what the patient tells you

– SignsSigns: can be seen, heard , felt, smelled or : can be seen, heard , felt, smelled or measured measured

Chief Complaint (Chief Complaint (CCCC); Mechanism of Injury ); Mechanism of Injury ((MOIMOI):):– Chief complaints are the major signs, Chief complaints are the major signs,

symptoms or events that caused the call or symptoms or events that caused the call or complaintcomplaint

– SymptomsSymptoms: what the patient tells you: what the patient tells you

– SignsSigns: can be seen, heard , felt, smelled or : can be seen, heard , felt, smelled or measured measured

Obtaining a SAMPLE HistoryObtaining a SAMPLE History

S S :: Signs and Symptoms of the episode:Signs and Symptoms of the episode:– What signs and symptoms occurred at onset?What signs and symptoms occurred at onset?– Does the patient report pain?Does the patient report pain?

S S :: Signs and Symptoms of the episode:Signs and Symptoms of the episode:– What signs and symptoms occurred at onset?What signs and symptoms occurred at onset?– Does the patient report pain?Does the patient report pain?

Obtaining a SAMPLE HistoryObtaining a SAMPLE History AA :: Allergies:Allergies:

– Is the patient allergic to medications, foods or Is the patient allergic to medications, foods or other substance?other substance?

– What reactions did the patient have to any of What reactions did the patient have to any of them?them?

Note: If the patient has no know allergies, you Note: If the patient has no know allergies, you should note this on the run sheet as “no should note this on the run sheet as “no known allergies” or “NKA” known allergies” or “NKA”

AA :: Allergies:Allergies:– Is the patient allergic to medications, foods or Is the patient allergic to medications, foods or

other substance?other substance?– What reactions did the patient have to any of What reactions did the patient have to any of

them?them?

Note: If the patient has no know allergies, you Note: If the patient has no know allergies, you should note this on the run sheet as “no should note this on the run sheet as “no known allergies” or “NKA” known allergies” or “NKA”


M M :: Medications:Medications:– What medications was the patient prescribed?What medications was the patient prescribed?– What dosage was prescribed?What dosage was prescribed?– How often is the patient supposed to take the How often is the patient supposed to take the

medication? medication? – What prescription, over-the-counter (OTC) What prescription, over-the-counter (OTC)

medications, and herbal medications has the medications, and herbal medications has the patient taken in the last 12 hours?patient taken in the last 12 hours?

– How much was taken and when? How much was taken and when?

M M :: Medications:Medications:– What medications was the patient prescribed?What medications was the patient prescribed?– What dosage was prescribed?What dosage was prescribed?– How often is the patient supposed to take the How often is the patient supposed to take the

medication? medication? – What prescription, over-the-counter (OTC) What prescription, over-the-counter (OTC)

medications, and herbal medications has the medications, and herbal medications has the patient taken in the last 12 hours?patient taken in the last 12 hours?

– How much was taken and when? How much was taken and when?


P P :: Pertinent past history:Pertinent past history:– Does the patient have any history of medical, Does the patient have any history of medical,

surgical, or trauma occurrences?surgical, or trauma occurrences?– Has the patient had a recent illness or injury, fall Has the patient had a recent illness or injury, fall

or blow to the head? or blow to the head?

P P :: Pertinent past history:Pertinent past history:– Does the patient have any history of medical, Does the patient have any history of medical,

surgical, or trauma occurrences?surgical, or trauma occurrences?– Has the patient had a recent illness or injury, fall Has the patient had a recent illness or injury, fall

or blow to the head? or blow to the head?


L L :: Last oral intake:Last oral intake:– When did the patient last eat or drink?When did the patient last eat or drink?– What did the patient eat or drink, and how What did the patient eat or drink, and how

much was consumed?much was consumed?– Did the patient take any drugs or drink alcohol?Did the patient take any drugs or drink alcohol?– Has there been any other oral intake in the last Has there been any other oral intake in the last

4 hours? 4 hours?

L L :: Last oral intake:Last oral intake:– When did the patient last eat or drink?When did the patient last eat or drink?– What did the patient eat or drink, and how What did the patient eat or drink, and how

much was consumed?much was consumed?– Did the patient take any drugs or drink alcohol?Did the patient take any drugs or drink alcohol?– Has there been any other oral intake in the last Has there been any other oral intake in the last

4 hours? 4 hours?


E E :: Events leading to injury or illnessEvents leading to injury or illness– What are the key events that led up to this What are the key events that led up to this

incident?incident?– What occurred between the onset of the What occurred between the onset of the

incident and your arrival?incident and your arrival?– What was the patient doing when this illness What was the patient doing when this illness

started?started?– What was the patient doing when this injury What was the patient doing when this injury

happened? happened?

E E :: Events leading to injury or illnessEvents leading to injury or illness– What are the key events that led up to this What are the key events that led up to this

incident?incident?– What occurred between the onset of the What occurred between the onset of the

incident and your arrival?incident and your arrival?– What was the patient doing when this illness What was the patient doing when this illness

started?started?– What was the patient doing when this injury What was the patient doing when this injury

happened? happened?

OO--PP--QQ--RR--SS--TT

Mnemonic device to help you remember Mnemonic device to help you remember questions you should ask to obtain a questions you should ask to obtain a patient history.patient history.– OO : Onset: When did the problem begin and : Onset: When did the problem begin and

what caused it?what caused it?

– PP : Provocation or Palliation: Does anything : Provocation or Palliation: Does anything make it feel better? Worse?make it feel better? Worse?

Mnemonic device to help you remember Mnemonic device to help you remember questions you should ask to obtain a questions you should ask to obtain a patient history.patient history.– OO : Onset: When did the problem begin and : Onset: When did the problem begin and

what caused it?what caused it?

– PP : Provocation or Palliation: Does anything : Provocation or Palliation: Does anything make it feel better? Worse?make it feel better? Worse?

OO--PP--QQ--RR--SS--TT

– QQ : Quality: What is the pain like? Sharp, dull, : Quality: What is the pain like? Sharp, dull, crushing, tearing?crushing, tearing?

– RR : Region/Radiation: Where does it hurt? : Region/Radiation: Where does it hurt? Does the pain move anywhere?Does the pain move anywhere?

– SS : Severity: On a scale of 1 to 10, how would : Severity: On a scale of 1 to 10, how would you rate your pain?you rate your pain?

– TT : Timing of pain: Has the pain been constant : Timing of pain: Has the pain been constant or does it come and go? How long have you or does it come and go? How long have you had the pain?had the pain?

– QQ : Quality: What is the pain like? Sharp, dull, : Quality: What is the pain like? Sharp, dull, crushing, tearing?crushing, tearing?

– RR : Region/Radiation: Where does it hurt? : Region/Radiation: Where does it hurt? Does the pain move anywhere?Does the pain move anywhere?

– SS : Severity: On a scale of 1 to 10, how would : Severity: On a scale of 1 to 10, how would you rate your pain?you rate your pain?

– TT : Timing of pain: Has the pain been constant : Timing of pain: Has the pain been constant or does it come and go? How long have you or does it come and go? How long have you had the pain?had the pain?

Baseline Vital SignsBaseline Vital Signs

Baseline vital signs always include Baseline vital signs always include – Respirations, Pulse & Blood PressureRespirations, Pulse & Blood Pressure

Other key indicators:Other key indicators:– Skin: color, condition, temperature (Skin: color, condition, temperature (CCTCCT))

– Capillary refill time (in children)Capillary refill time (in children)

– Pupillary responsePupillary response

– Level of Consciousness (Level of Consciousness (LOCLOC))

– Sometimes Temperature (medical Sometimes Temperature (medical patients)patients)

Baseline vital signs always include Baseline vital signs always include – Respirations, Pulse & Blood PressureRespirations, Pulse & Blood Pressure

Other key indicators:Other key indicators:– Skin: color, condition, temperature (Skin: color, condition, temperature (CCTCCT))

– Capillary refill time (in children)Capillary refill time (in children)

– Pupillary responsePupillary response

– Level of Consciousness (Level of Consciousness (LOCLOC))

– Sometimes Temperature (medical Sometimes Temperature (medical patients)patients)

RespirationsRespirations

A patient who is breathing without A patient who is breathing without assistance: assistance: spontaneous respirationsspontaneous respirations. .

Each complete breath consists of two Each complete breath consists of two distinct phases: distinct phases: – Inspiration (inhalation): the chest rises up and Inspiration (inhalation): the chest rises up and

out, drawing oxygenated air into the lungs out, drawing oxygenated air into the lungs

– Expiration (exhalation): the chest returns to its Expiration (exhalation): the chest returns to its original position, releasing air with an increased original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs carbon dioxide (CO²) level out of the lungs

A patient who is breathing without A patient who is breathing without assistance: assistance: spontaneous respirationsspontaneous respirations. .

Each complete breath consists of two Each complete breath consists of two distinct phases: distinct phases: – Inspiration (inhalation): the chest rises up and Inspiration (inhalation): the chest rises up and

out, drawing oxygenated air into the lungs out, drawing oxygenated air into the lungs

– Expiration (exhalation): the chest returns to its Expiration (exhalation): the chest returns to its original position, releasing air with an increased original position, releasing air with an increased carbon dioxide (CO²) level out of the lungs carbon dioxide (CO²) level out of the lungs


Rate:Rate:– The number of breaths in 30 seconds x 2The number of breaths in 30 seconds x 2

Quality: character of breathing:Quality: character of breathing:– Rhythm (regular or irregular)Rhythm (regular or irregular)

– Effort (normal or labored)Effort (normal or labored) Depth:Depth: - Tidal Volume (the amount of air exchanged with each - Tidal Volume (the amount of air exchanged with each

breath)breath)

-Depth and rate of breathing determines the tidal -Depth and rate of breathing determines the tidal volumevolume

Rate:Rate:– The number of breaths in 30 seconds x 2The number of breaths in 30 seconds x 2

Quality: character of breathing:Quality: character of breathing:– Rhythm (regular or irregular)Rhythm (regular or irregular)

– Effort (normal or labored)Effort (normal or labored) Depth:Depth: - Tidal Volume (the amount of air exchanged with each - Tidal Volume (the amount of air exchanged with each

breath)breath)

-Depth and rate of breathing determines the tidal -Depth and rate of breathing determines the tidal volumevolume

Respiratory RateRespiratory Rate

Adults: 12 to 20 breaths/minuteAdults: 12 to 20 breaths/minute(over age 8)(over age 8)

Children: 18 to 30 breaths/minuteChildren: 18 to 30 breaths/minute(1 to 8 years of age)(1 to 8 years of age)

Infants: 30 to 60 breaths/minuteInfants: 30 to 60 breaths/minute(under 1 year of age)(under 1 year of age)

Adults: 12 to 20 breaths/minuteAdults: 12 to 20 breaths/minute(over age 8)(over age 8)

Children: 18 to 30 breaths/minuteChildren: 18 to 30 breaths/minute(1 to 8 years of age)(1 to 8 years of age)

Infants: 30 to 60 breaths/minuteInfants: 30 to 60 breaths/minute(under 1 year of age)(under 1 year of age)


Effort (labored):Effort (labored):– Unable to speak more than 2-3 words at a timeUnable to speak more than 2-3 words at a time– Assuming a “tripod” positionAssuming a “tripod” position– Assuming a “sniffing” position (children)Assuming a “sniffing” position (children)– Noisy breathing:Noisy breathing:

• StridorStridor• Wheezes, snoringWheezes, snoring• Coughing (productive?) Coughing (productive?)

Effort (labored):Effort (labored):– Unable to speak more than 2-3 words at a timeUnable to speak more than 2-3 words at a time– Assuming a “tripod” positionAssuming a “tripod” position– Assuming a “sniffing” position (children)Assuming a “sniffing” position (children)– Noisy breathing:Noisy breathing:

• StridorStridor• Wheezes, snoringWheezes, snoring• Coughing (productive?) Coughing (productive?)

Pulse OximetryPulse Oximetry

Evaluates the effectiveness of oxygenation.Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%.Normal value: 95% - 100%.

Evaluates the effectiveness of oxygenation.Evaluates the effectiveness of oxygenation. Normal value: 95% - 100%.Normal value: 95% - 100%.

PulsePulse

With each heartbeat, ventricle contract, With each heartbeat, ventricle contract, forcefully ejecting blood from the heart forcefully ejecting blood from the heart and propelling it into the arteries.and propelling it into the arteries.

A pulse is the pressure wave that occurs A pulse is the pressure wave that occurs as each heartbeat causes a surge in the as each heartbeat causes a surge in the blood circulating through the arteries. blood circulating through the arteries.

With each heartbeat, ventricle contract, With each heartbeat, ventricle contract, forcefully ejecting blood from the heart forcefully ejecting blood from the heart and propelling it into the arteries.and propelling it into the arteries.

A pulse is the pressure wave that occurs A pulse is the pressure wave that occurs as each heartbeat causes a surge in the as each heartbeat causes a surge in the blood circulating through the arteries. blood circulating through the arteries.

PulsePulse

Carotid Pulse Radial Pulse Carotid Pulse Radial Pulse

PulsePulse

Brachial PulseBrachial Pulse

PulsePulse

Rate:Rate:– Number of beats in 30 seconds x 2Number of beats in 30 seconds x 2

Strength:Strength:– Stronger than normal (Stronger than normal (boundingbounding), strong or ), strong or

weak (weak (threadythready))

Regularity:Regularity:– Regular or irregularRegular or irregular

Rate:Rate:– Number of beats in 30 seconds x 2Number of beats in 30 seconds x 2

Strength:Strength:– Stronger than normal (Stronger than normal (boundingbounding), strong or ), strong or

weak (weak (threadythready))

Regularity:Regularity:– Regular or irregularRegular or irregular

29

Normal Pulse Ranges Normal Pulse Ranges

Adults: Adults: 60 to 100 beats/minute60 to 100 beats/minute

Children:Children: 70 to 120 beats/minute70 to 120 beats/minute

Toddlers:Toddlers: 90 to 150 beats/minute90 to 150 beats/minute

Newborns:Newborns: 120 to 160 beats/minute120 to 160 beats/minute

Adults: Adults: 60 to 100 beats/minute60 to 100 beats/minute

Children:Children: 70 to 120 beats/minute70 to 120 beats/minute

Toddlers:Toddlers: 90 to 150 beats/minute90 to 150 beats/minute

Newborns:Newborns: 120 to 160 beats/minute120 to 160 beats/minute

The SkinThe Skin

The condition of the patient’s skin can tell The condition of the patient’s skin can tell you a lot about the patient’s:you a lot about the patient’s:– Peripheral circulation and perfusionPeripheral circulation and perfusion– Blood oxygen levelsBlood oxygen levels– Body temperatureBody temperature

The condition of the patient’s skin can tell The condition of the patient’s skin can tell you a lot about the patient’s:you a lot about the patient’s:– Peripheral circulation and perfusionPeripheral circulation and perfusion– Blood oxygen levelsBlood oxygen levels– Body temperatureBody temperature

The Skin (The Skin (CCTCCT))

Color:Color:– Pink, pale, blue, Pink, pale, blue,

red, or yellowred, or yellow Condition: Condition:

(moisture)(moisture)– Dry, moist or wetDry, moist or wet

Temperature:Temperature:– Warm, hot or coolWarm, hot or cool

Color:Color:– Pink, pale, blue, Pink, pale, blue,

red, or yellowred, or yellow Condition: Condition:

(moisture)(moisture)– Dry, moist or wetDry, moist or wet

Temperature:Temperature:– Warm, hot or coolWarm, hot or cool

Capillary RefillCapillary Refill

Evaluates the ability of the circulatory Evaluates the ability of the circulatory system to restore blood to the capillary system to restore blood to the capillary system (perfusion).system (perfusion).

– Evaluated at the nail bed (finger) Evaluated at the nail bed (finger)

– Depress the finger tip, pressure forcing blood Depress the finger tip, pressure forcing blood from the capillaries and look for return of bloodfrom the capillaries and look for return of blood

Evaluates the ability of the circulatory Evaluates the ability of the circulatory system to restore blood to the capillary system to restore blood to the capillary system (perfusion).system (perfusion).

– Evaluated at the nail bed (finger) Evaluated at the nail bed (finger)

– Depress the finger tip, pressure forcing blood Depress the finger tip, pressure forcing blood from the capillaries and look for return of bloodfrom the capillaries and look for return of blood

Capillary RefillCapillary Refill

– As the capillaries refill, As the capillaries refill, should return to its should return to its normal deep pink colornormal deep pink color

– Color should be restored Color should be restored within 2 seconds (about within 2 seconds (about the time it takes to say, the time it takes to say, ““Capillary refillCapillary refill” ”

– Invalid test in a cold Invalid test in a cold environment; elderlyenvironment; elderly

– Used for < 6 years oldUsed for < 6 years old

– As the capillaries refill, As the capillaries refill, should return to its should return to its normal deep pink colornormal deep pink color

– Color should be restored Color should be restored within 2 seconds (about within 2 seconds (about the time it takes to say, the time it takes to say, ““Capillary refillCapillary refill” ”

– Invalid test in a cold Invalid test in a cold environment; elderlyenvironment; elderly

– Used for < 6 years oldUsed for < 6 years old

Blood Pressure Blood Pressure

Blood pressure is a vital sign. Blood pressure is a vital sign. Pressure of circulating blood against the Pressure of circulating blood against the

walls of the arteries.walls of the arteries. A drop in blood pressure may indicate:A drop in blood pressure may indicate:

– Loss of bloodLoss of blood– Loss of vascular toneLoss of vascular tone– Cardiac pumping problemCardiac pumping problem

Blood pressure should be measured in all Blood pressure should be measured in all patients older than 3 years of age.patients older than 3 years of age.

Blood pressure is a vital sign. Blood pressure is a vital sign. Pressure of circulating blood against the Pressure of circulating blood against the

walls of the arteries.walls of the arteries. A drop in blood pressure may indicate:A drop in blood pressure may indicate:

– Loss of bloodLoss of blood– Loss of vascular toneLoss of vascular tone– Cardiac pumping problemCardiac pumping problem

Blood pressure should be measured in all Blood pressure should be measured in all patients older than 3 years of age.patients older than 3 years of age.

Blood PressureBlood Pressure

Diastolic:Diastolic:– Pressure during relaxing Pressure during relaxing

phase of the heart’s cyclephase of the heart’s cycle Systolic:Systolic:

– Pressure during contractionPressure during contraction Measured as millimeters Measured as millimeters

of mercury (mmHg).of mercury (mmHg). Recorded as systolic/diastolic.Recorded as systolic/diastolic.

Diastolic:Diastolic:– Pressure during relaxing Pressure during relaxing

phase of the heart’s cyclephase of the heart’s cycle Systolic:Systolic:

– Pressure during contractionPressure during contraction Measured as millimeters Measured as millimeters

of mercury (mmHg).of mercury (mmHg). Recorded as systolic/diastolic.Recorded as systolic/diastolic.

Blood Pressure EquipmentBlood Pressure Equipment

Auscultation of Blood PressureAuscultation of Blood Pressure

Place cuff on patient's arm (1” above elbow).Place cuff on patient's arm (1” above elbow). Palpate brachial artery and place diaphragm Palpate brachial artery and place diaphragm

of stethoscope over artery.of stethoscope over artery. Inflate cuff until you no Inflate cuff until you no

longer hear pulse sounds.longer hear pulse sounds. Continue pumping to Continue pumping to

increase pressure by increase pressure by an additional 20 mmHg.an additional 20 mmHg.

Place cuff on patient's arm (1” above elbow).Place cuff on patient's arm (1” above elbow). Palpate brachial artery and place diaphragm Palpate brachial artery and place diaphragm

of stethoscope over artery.of stethoscope over artery. Inflate cuff until you no Inflate cuff until you no

longer hear pulse sounds.longer hear pulse sounds. Continue pumping to Continue pumping to

increase pressure by increase pressure by an additional 20 mmHg.an additional 20 mmHg.

Auscultation of Blood PressureAuscultation of Blood Pressure

Note the systolic and Note the systolic and diastolic pressures diastolic pressures as you let air escape as you let air escape slowly.slowly.

As soon as pulse As soon as pulse sounds stop, open the sounds stop, open the valve and release the valve and release the air quickly. air quickly.

Note the systolic and Note the systolic and diastolic pressures diastolic pressures as you let air escape as you let air escape slowly.slowly.

As soon as pulse As soon as pulse sounds stop, open the sounds stop, open the valve and release the valve and release the air quickly. air quickly.

Palpation of Blood PressurePalpation of Blood Pressure

Secure cuff.Secure cuff. Locate radial pulse.Locate radial pulse. After the pulse disappears After the pulse disappears

continue to inflate another continue to inflate another 30mmHg.30mmHg.

Release air until pulse is Release air until pulse is felt.felt.

Method only obtains Method only obtains systolic pressure.systolic pressure.

Secure cuff.Secure cuff. Locate radial pulse.Locate radial pulse. After the pulse disappears After the pulse disappears

continue to inflate another continue to inflate another 30mmHg.30mmHg.

Release air until pulse is Release air until pulse is felt.felt.

Method only obtains Method only obtains systolic pressure.systolic pressure.

Normal BP RangesNormal BP Ranges

Age Range

Adults 90 to 140 mmHg (s)

60 to 90 mmHg (d)

Children (1-8) 80 to 110 mmHg (s)

Infants (up to 1 yr) 50 to 90 mmHg (s)

*Varies with age and gender.

Age Range

Adults 90 to 140 mmHg (s)

60 to 90 mmHg (d)

Children (1-8) 80 to 110 mmHg (s)

Infants (up to 1 yr) 50 to 90 mmHg (s)

*Varies with age and gender.

Blood PressureBlood Pressure

HypotensionHypotension: : – BP significantly lower than the normal rangeBP significantly lower than the normal range– Critical hypotension: BP is no longer able to Critical hypotension: BP is no longer able to

compensate sufficiently to maintain adequate compensate sufficiently to maintain adequate perfusion perfusion

HypertensionHypertension::– BP significantly higher than the normal rangeBP significantly higher than the normal range

HypotensionHypotension: : – BP significantly lower than the normal rangeBP significantly lower than the normal range– Critical hypotension: BP is no longer able to Critical hypotension: BP is no longer able to

compensate sufficiently to maintain adequate compensate sufficiently to maintain adequate perfusion perfusion

HypertensionHypertension::– BP significantly higher than the normal rangeBP significantly higher than the normal range

Level of ConsciousnessLevel of Consciousness

AA - - AAlertlert

VV - Responsive to - Responsive to

VVerbal stimuluserbal stimulus

PP - Responsive to - Responsive to PPainain

UU - - UUnresponsivenresponsive

AA - - AAlertlert

VV - Responsive to - Responsive to

VVerbal stimuluserbal stimulus

PP - Responsive to - Responsive to PPainain

UU - - UUnresponsivenresponsive

Pupil AssessmentPupil Assessment

PP - - PPupilsupils

EE - - EEqualqual

AA - - AAndnd

RR - - RRoundound

RR - - RRegular in sizeegular in size

LL - React to - React to LLightight

PP - - PPupilsupils

EE - - EEqualqual

AA - - AAndnd

RR - - RRoundound

RR - - RRegular in sizeegular in size

LL - React to - React to LLightight

Abnormal Pupil ReactionsAbnormal Pupil Reactions

Reassessment of Vital SignsReassessment of Vital Signs

The vital signs you obtain serve two The vital signs you obtain serve two important functions:important functions:

– First set establishes a baseline of respiratory First set establishes a baseline of respiratory and cardiovascular system statusand cardiovascular system status

– Serves as a key baseline Serves as a key baseline

The vital signs you obtain serve two The vital signs you obtain serve two important functions:important functions:

– First set establishes a baseline of respiratory First set establishes a baseline of respiratory and cardiovascular system statusand cardiovascular system status

– Serves as a key baseline Serves as a key baseline

Reassessment of Vital SignsReassessment of Vital Signs

Reassess Reassess stablestable patients every patients every 1515 minutes. minutes.

Reassess Reassess unstableunstable patients every patients every 55 minutes. minutes.

Reassess/record Reassess/record VS after all medical VS after all medical interventions. interventions.

Reassess Reassess stablestable patients every patients every 1515 minutes. minutes.

Reassess Reassess unstableunstable patients every patients every 55 minutes. minutes.

Reassess/record Reassess/record VS after all medical VS after all medical interventions. interventions.

EENT Disorders EENT Disorders

Eyes, Ears, Nose, and Throat disorders Eyes, Ears, Nose, and Throat disorders are commonly found during sick call and are commonly found during sick call and in the field, and medical personnel need in the field, and medical personnel need to be able to accurately assess patients to be able to accurately assess patients as well as treat them.as well as treat them.

Eyes, Ears, Nose, and Throat disorders Eyes, Ears, Nose, and Throat disorders are commonly found during sick call and are commonly found during sick call and in the field, and medical personnel need in the field, and medical personnel need to be able to accurately assess patients to be able to accurately assess patients as well as treat them.as well as treat them.

Lacrimal Glands

Sclera

1.

Pupil

Structures of the EyeIris

2.

3. 4.

6

5

7

8 9

10

Eye AnatomyEye Anatomy

ConjunctivaConjunctiva

ScleraSclera

RetinaRetina

Cornea Cornea . .

LensLens

IrisIris

PupilPupil

Lacrimal Lacrimal GlandsGlands

ConjunctivaConjunctiva

ScleraSclera

RetinaRetina

Cornea Cornea . .

LensLens

IrisIris

PupilPupil

Lacrimal Lacrimal GlandsGlands

Mucus membrane that lines the eyelidMucus membrane that lines the eyelid

White of the eyeWhite of the eye

Contains rods and conesContains rods and cones

Tough and Transparent Covers Pupil Tough and Transparent Covers Pupil and Irisand Iris

Adjusts focus of eyeAdjusts focus of eye

Controls light entering eyeControls light entering eye

Window of the eyeWindow of the eye

Moistens the eyeMoistens the eye

Assessment of Ocular ComplaintsAssessment of Ocular Complaints

Gathering the Patient’s History

MOI? Blunt trauma or penetrating trauma?

Glasses or contact lenses?

Eye disease or previous trauma/surgery?

Pain? Loss of Vision? One eye or both?

Gathering the Patient’s History

MOI? Blunt trauma or penetrating trauma?

Glasses or contact lenses?

Eye disease or previous trauma/surgery?

Pain? Loss of Vision? One eye or both?

Soldier vs crowbar Soldier vs aluminum shard


Physical Examination

Visual Acuity Screening

What is one tool used to assess visual acuity?

Snellen Visual Acuity Test

You should complete a visual acuity screening on all patient’s with an ocular complaint except…

Ocular Burns

Physical Examination

Visual Acuity Screening

What is one tool used to assess visual acuity?

Snellen Visual Acuity Test

You should complete a visual acuity screening on all patient’s with an ocular complaint except…

Ocular Burns

Discuss: Discuss: Indication, Purpose and Procedure Indication, Purpose and Procedure for the for the

Snellen Visual Acuity Snellen Visual Acuity TestTest

Gross Vision ExaminationGross Vision ExaminationVisual Acuity testing can be conducted even

when equipment, lighting, space and environment are not “ideal”.

What other ways can vision be measured?

Near Card or Printed Material

Counting Fingers

Light / Dark Distinction

Visual Acuity testing can be conducted even when equipment, lighting, space and

environment are not “ideal”.

What other ways can vision be measured?

Near Card or Printed Material

Counting Fingers

Light / Dark Distinction

Near CardNear Card

What abnormalities do you see?What abnormalities do you see?

BLOOD IN THE ANTERIOR CHAMBERBLOOD IN THE ANTERIOR CHAMBER


RED CONJUNCTIVA AND SCLERARED CONJUNCTIVA AND SCLERA


UNEQUAL PUPILSUNEQUAL PUPILS


LACERATION TO THE EYE LIDLACERATION TO THE EYE LID


Physical Examination Con’t.

You have gathered a history and completed a visual acuity test.

What other parts of the eye should be assessed?

Eyelids – Conjunctiva – Sclera – Pupils

Note any abnormalities, drainage or bleeding

Physical Examination Con’t.

You have gathered a history and completed a visual acuity test.

What other parts of the eye should be assessed?

Eyelids – Conjunctiva – Sclera – Pupils

Note any abnormalities, drainage or bleeding

Eye ComplaintsEye Complaints

Loss of Vision

Eye Pain with Decrease in Vision

History of Trauma

What should you do with a patient that presents with a red flag?

Refer to medical officer

Loss of Vision


History of Trauma

What should you do with a patient that presents with a red flag?


RED FLAGS

Common Eye ComplaintsCommon Eye Complaints

What is Red Eye?

A sign of many possible eye problems.

What are the possible causes of Red Eye?

Infection, Allergies, Drugs, Chemical Exposure, Trauma, Systematic Disease

What causes the “red” appearance?

Vascular dilation & engorgement of the sclera and conjunctiva.

What is Red Eye?

A sign of many possible eye problems.

What are the possible causes of Red Eye?

Infection, Allergies, Drugs, Chemical Exposure, Trauma, Systematic Disease

What causes the “red” appearance?

Vascular dilation & engorgement of the sclera and conjunctiva.

Red Eye Due to Infection

Red Eye Due to Chemical Burns

Examples of “Red Eye”Examples of “Red Eye”

What is the most common cause of red eye?Conjunctivitis

What is conjunctivitis?The sclera and conjunctivae are reddened. Clear watery (viral or allergy) or purulent (bacterial) discharge.

What are some of the Chief Complaints?

What is the most common cause of red eye?Conjunctivitis

What is conjunctivitis?The sclera and conjunctivae are reddened. Clear watery (viral or allergy) or purulent (bacterial) discharge.

What are some of the Chief Complaints?

Common Eye ComplaintsCommon Eye Complaints

• Eye Discharge

• Blurry Vision

• Grittiness

• Redness

• Burning

• Sneezing and Nasal Discharge(Allergic Conjunctivitis)

Bacterial ConjunctivitisBacterial Conjunctivitis

Usually starts in one eye, may spread to other eye

Sclera and conjunctivae are commonly reddened with a purulent (pus-like) discharge

Viral ConjunctivitisViral Conjunctivitis

Usually starts in one eye, may spread to other eye

Sclera and conjunctivae are commonly reddened with a clear, watery discharge

Check on your learning…Check on your learning…

When recording distant vision visual acuity, what does each number mean?

Distance away from Chart

Distance normal eye can read the line

What is the procedure for examining the conjunctiva? Normal findings?

Ask patient to look upward - you pull lower lid downward

Normal: Pink to dark pink color

Abnormal: erythema (redness) or exudates (pus)

When recording distant vision visual acuity, what does each number mean?

Distance away from Chart

Distance normal eye can read the line

What is the procedure for examining the conjunctiva? Normal findings?

Ask patient to look upward - you pull lower lid downward

Normal: Pink to dark pink color

Abnormal: erythema (redness) or exudates (pus)

20 200

Check on your learning…Check on your learning…Abbreviations for:

Right Eye

Left Eye

Both Eyes

What are the Red Flags of Eye Complaints?Loss of Vision


History of Trauma

Abbreviations for:

Right Eye

Left Eye

Both Eyes

What are the Red Flags of Eye Complaints?Loss of Vision


History of Trauma

O.D.

O.S.

O.U.

Structures of the EarStructures of the Ear

1

2

34

6

5

7

8

Ossicles of the Middle EarOssicles of the Middle Ear

Stapes

Incus (Anvil)

Malleus (Hammer)

The Eustachian TubeThe Eustachian Tube

Ear AnatomyEar Anatomy

Pinna (Auricle)

Eustachian Tube

External Auditory Canal (EAC)

Tympanic Membrane (TM)

Pinna (Auricle)

Eustachian Tube

External Auditory Canal (EAC)

Tympanic Membrane (TM)

External part of ear collects External part of ear collects fluid waves and directs into fluid waves and directs into the earthe ear

Drain middle ear into the Drain middle ear into the nasopharynxnasopharynx

Pathway from the external ear Pathway from the external ear to the tympanic membraneto the tympanic membrane

Ear Drum. Thin translucent Ear Drum. Thin translucent membranemembrane

Physical Exam of the EarPhysical Exam of the Ear

The AuricleInspect

Palpate

Inspect this patient.

What should be noted?

The AuricleInspect

Palpate

Inspect this patient.

What should be noted?


External Auditory CanalInspect for discharge

What do you see in each of

these EACs?

External Auditory CanalInspect for discharge

What do you see in each of

these EACs?

Can you do any further inspection of

this ear?

What would you do next?


The Otoscope

What is inspected?

EAC and TM

Use what sized speculum?

The largest the canal will

accommodate.

As you insert the speculum,

what should you look for?Discharges, Lesions, Narrowing of the EAC, Foreign

Bodies, Presence of Cerumen

The Otoscope

What is inspected?

EAC and TM

Use what sized speculum?

The largest the canal will

accommodate.

As you insert the speculum,

what should you look for?Discharges, Lesions, Narrowing of the EAC, Foreign

Bodies, Presence of Cerumen


Tympanic Membrane This is what normal looks like

Tympanic Membrane This is what normal looks like


Tympanic MembraneWhat abnormalities do you see?

Tympanic MembraneWhat abnormalities do you see?

Perforations Scarring

Physical Exam of the EarPhysical Exam of the EarTympanic Membrane

What abnormalities do you see?

Bubbles Air/Fluid Levels

Inner Ear ExamsInner Ear Exams

The inner ear is tested by evaluating the patient’s hearing.

What type of hearing test do you perform on the patient?

A gross hearing test.

Does the patient respond to your questions?

AND - Note patient’s balance.

The inner ear is tested by evaluating the patient’s hearing.

What type of hearing test do you perform on the patient?

A gross hearing test.

Does the patient respond to your questions?

AND - Note patient’s balance.

Ear ComplaintsEar Complaints

Fever of 101 degrees F or greater

Embedded Foreign Objects

What should you do with a patient who has a fever and complaining of ear pain?




What should you do with a patient who has a fever and complaining of ear pain?


RED FLAGS

Common Ear ComplaintsCommon Ear Complaints

Cerumen (Ear Wax) Impaction Patient’s Chief Complaint? Hearing Loss Definition? Build up of ear wax Pain or No Pain? USUALLY pain is not present Cause? Natural by-product of the body

Ear Irrigation?Once the medic has been trained to irrigate by a medical

officer. Ear drops may be given to dissolve the wax.

Cerumen (Ear Wax) Impaction Patient’s Chief Complaint? Hearing Loss Definition? Build up of ear wax Pain or No Pain? USUALLY pain is not present Cause? Natural by-product of the body

Ear Irrigation?Once the medic has been trained to irrigate by a medical

officer. Ear drops may be given to dissolve the wax.

Otitis Externa (Swimmer’s Ear)Patient’s Chief Complaint?Pain, canal swelling, drainageDefinition?Inflammation/infection of external ear canalPain or No pain?Pain (maybe severe), increases with external ear movementCause?Bacterial or fungal (rare) infection

Medical Officer Referral?Refer. Medical Officer may recommend antibiotic/steroid

ear drops. Possibly Motrin for the pain.

Otitis Externa (Swimmer’s Ear)Patient’s Chief Complaint?Pain, canal swelling, drainageDefinition?Inflammation/infection of external ear canalPain or No pain?Pain (maybe severe), increases with external ear movementCause?Bacterial or fungal (rare) infection

Medical Officer Referral?Refer. Medical Officer may recommend antibiotic/steroid

ear drops. Possibly Motrin for the pain.

Common Ear ComplaintsCommon Ear Complaints

Common Ear ComplaintsCommon Ear ComplaintsOtitis Media

Patient’s Chief Complaint?Pain, fever, nasal congestion, cough

Definition?Middle Ear Infection

Pain or No pain?Yes and decreased hearing in affected ear

Refer?Yes.

Medical Officer may recommend antibiotics and/or decongestants.

Otitis Media

Patient’s Chief Complaint?Pain, fever, nasal congestion, cough

Definition?Middle Ear Infection

Pain or No pain?Yes and decreased hearing in affected ear

Refer?Yes.

Medical Officer may recommend antibiotics and/or decongestants.

Abnormal Foreign Body

Embedded Tic after removal by Medical Officer

Normal Tympanic MembraneNormal Tympanic Membrane

Abnormal – Ear Vs Pencil EraserAbnormal – Ear Vs Pencil Eraser

Check on your learning…Check on your learning…Patient c/o ear pain, especially upon touch.

He has a temperature of 99 degrees.

You inspect the ear and see…

What is the possible problem?

Otitis Externa

Should you irrigate?

Management?

Antibiotic/steroid ear drop

NSAID (Motrin) for the pain

Patient c/o ear pain, especially upon touch.

He has a temperature of 99 degrees.


What is the possible problem?

Otitis Externa

Should you irrigate?

Management?

Antibiotic/steroid ear drop

NSAID (Motrin) for the pain

No


Your patient complains of ear pain and decreased hearing. She has a fever of 102 degrees.


What is the possible problem?Otitis Media

Viral or Bacteria?

Management?Refer to a Medical Officer for

oral antibiotics and decongestants.

Your patient complains of ear pain and decreased hearing. She has a fever of 102 degrees.


What is the possible problem?Otitis Media

Viral or Bacteria?

Management?Refer to a Medical Officer for

oral antibiotics and decongestants.

Pus behind the ear drum

Structures of the NoseStructures of the Nose

Nare

Frontal

Maxilla

1

2

3

Structures of the SinuesStructures of the Sinues

1

2

3

Physical Exam of the NosePhysical Exam of the NoseInspect for Shape, Size, Symmetry, Color,

Presence of Deformities or Lesions.

Palpate for Tenderness, Swelling, Masses.

What do you see?

Inspect for Shape, Size, Symmetry, Color, Presence of Deformities or Lesions.

Palpate for Tenderness, Swelling, Masses.

What do you see?

Physical Exams of the Sinuses Physical Exams of the Sinuses

Which two sinuses are accessible for physical examination?

Maxillary and Frontal

Inspect for swelling

Palpate for tenderness

Which two sinuses are accessible for physical examination?

Maxillary and Frontal

Inspect for swelling

Palpate for tenderness

Sinus ComplaintsSinus Complaints


What should you do with a patient who has a fever and complains of sinus pain?

Refer to a medical officer


What should you do with a patient who has a fever and complains of sinus pain?


RED FLAGS

Common Complaints of the NoseCommon Complaints of the Nose

Epistaxis (ep-uh-stak-sis) Commonly known as?

Nosebleed

What are some common causes?External Trauma, Nose Picking,

Infection from Plucking Hairs, Vigorous Nose Blowing, Drying of Nasal Mucosa

Chronic nose bleeds could be early signs of what?

Hypertension (high blood pressure) or Blood Clotting Disorder

Epistaxis (ep-uh-stak-sis) Commonly known as?

Nosebleed

What are some common causes?External Trauma, Nose Picking,

Infection from Plucking Hairs, Vigorous Nose Blowing, Drying of Nasal Mucosa

Chronic nose bleeds could be early signs of what?

Hypertension (high blood pressure) or Blood Clotting Disorder

Epistaxis (ep-uh-stak-sis)What is your first priority?

Stop the Bleeding

Most cases should be treated how?Patient should sit up, lean forward, tip head down

Pinch entire nose firmly (10-15 min)

What if this doesn’t work?Use a vasoconstrictive spray (Afrin or NeoSynephrine)

If the patient has a history of nosebleeds, what else should be asked about?

Family History Medications (Aspirin, NSAIDs) History of Chronic Illnesses

Epistaxis (ep-uh-stak-sis)What is your first priority?

Stop the Bleeding

Most cases should be treated how?Patient should sit up, lean forward, tip head down


What if this doesn’t work?Use a vasoconstrictive spray (Afrin or NeoSynephrine)

If the patient has a history of nosebleeds, what else should be asked about?

Family History Medications (Aspirin, NSAIDs) History of Chronic Illnesses


If yes, REFER


Allergies (Allergic Rhinitis or Hay Fever)What is Rhinitis?

Inflammation of the nasal membranes

Once the sensitized immune system releases histamines what symptoms are caused?

Itching, Swelling of Tissues, Mucus Production, Hives, Rashes

What is used to treat minor and severe nasal congestion?

Minor – Decongestant Severe – Nasal Decongestion Spray (Afrin)

Afrin use should not exceed 3 days

Allergies (Allergic Rhinitis or Hay Fever)What is Rhinitis?

Inflammation of the nasal membranes

Once the sensitized immune system releases histamines what symptoms are caused?

Itching, Swelling of Tissues, Mucus Production, Hives, Rashes

What is used to treat minor and severe nasal congestion?

Minor – Decongestant Severe – Nasal Decongestion Spray (Afrin)

Afrin use should not exceed 3 days

Common Sinus ComplaintsCommon Sinus Complaints

What causes sinus complaints?

Anything that interferes with airflow into the sinuses or mucus flow out

What could interfere with air or mucus flow?

Swelling Tissue, Tumors, Thickening of Mucus, Damage to Cilia

What causes sinus complaints?

Anything that interferes with airflow into the sinuses or mucus flow out

What could interfere with air or mucus flow?

Swelling Tissue, Tumors, Thickening of Mucus, Damage to Cilia


Acute Sinusitis

Definition?Inflammation/infection of paranasal sinuses

Bacterial – Viral – Allergic

Acute Sinusitis

Definition?Inflammation/infection of paranasal sinuses

Bacterial – Viral – Allergic


Acute Sinusitis (con’t.)

Patient’s Chief Complaint?Headache, Facial Tenderness, Fever (few), Nasal Discharge and Stuffiness, Sore Throat, Cough,

Itchy Eyes*, Sneezing*

*Allergic Sinusitis

Should this patient be referred to a medical officer?Yes

How should the patient be managed?Antibiotics and decongestants.

Patient should be educated to avoid antihistamines.

Acute Sinusitis (con’t.)

Patient’s Chief Complaint?Headache, Facial Tenderness, Fever (few), Nasal Discharge and Stuffiness, Sore Throat, Cough,

Itchy Eyes*, Sneezing*

*Allergic Sinusitis

Should this patient be referred to a medical officer?Yes

How should the patient be managed?Antibiotics and decongestants.

Patient should be educated to avoid antihistamines.


A Soldier comes to you complaining of a nosebleed. What is your first priority?

What is the initial procedure?

A Soldier comes to you complaining of a nosebleed. What is your first priority?

What is the initial procedure?

Stop the Bleeding

Patient should sit up, lean forward, tip head down



Where should treatment for Allergic Rhinitis be aimed?

What is Sinusitis?

Where should treatment for Allergic Rhinitis be aimed?

What is Sinusitis?

Identification and avoidance Identification and avoidance of the offending allergen. of the offending allergen.

Inflammation/infection of the paranasal sinuses.Inflammation/infection of the paranasal sinuses.

Structures of the MouthStructures of the Mouth

Lips

Tongue

UvulaTonsils

Soft Palate

Hard Palate

TeethGums

1

2

3

4

5

6

7

8

Examination of the MouthExamination of the Mouth

LipsInspect and palpate for symmetry, color, edema

and abnormalities.

What do you see?

Examination of the Mouth Examination of the Mouth What is the procedure for examining the mucosa, teeth

and gums?

Patient is instructed to:Remove Dental Appliances Open MouthStick Out Tongue Say “Aaahhh”

Inspect with a Light and Tongue Depressor

WHAT ARE YOU LOOKING FOR?

Mouth and Throat ComplaintsMouth and Throat Complaints

RED FLAGS

Difficulty Breathing

Difficulty Swallowing


Tonsillar Exudates

If a patient displays any of these signs or symptoms, what should you do?


Common Complaints of the ThroatCommon Complaints of the Throat

Upper Respiratory InfectionDefinition?

Acute viral infection of the upper airway

Patient’s Chief Complaints?

Sore Throat, Nasal Congestion/Discharge

Low-Grade Fever, Sinus Pressure

Signs and Symptoms

Sore Throat and/or Cough (Both productive or not/clear or purulent)

Upper Respiratory InfectionDefinition?

Acute viral infection of the upper airway

Patient’s Chief Complaints?

Sore Throat, Nasal Congestion/Discharge

Low-Grade Fever, Sinus Pressure

Signs and Symptoms

Sore Throat and/or Cough (Both productive or not/clear or purulent)

Upper Respiratory InfectionPhysical Examination

How will the Pharynx look?Slightly reddened and mucous streaked

Lungs?Clear

Vital Signs?Normal

(possible low-grade fever)

Upper Respiratory InfectionPhysical Examination

How will the Pharynx look?Slightly reddened and mucous streaked

Lungs?Clear

Vital Signs?Normal

(possible low-grade fever)


Upper Respiratory Infection

Treatment is based on symptoms.Cough Suppressants, Decongestants,

Throat Lozenges,

Acetaminophen for fever and body aches

Are antibiotics indicated?

No

Upper Respiratory Infection

Treatment is based on symptoms.Cough Suppressants, Decongestants,

Throat Lozenges,

Acetaminophen for fever and body aches

Are antibiotics indicated?

No


Streptococcal Pharyngitis (Strep)Definition?Infection of the Posterior Pharynx and/or Tonsils

Common Cause?Group A Streptococcus bacteria

Patient’s Chief Complaint?Sore Throat, Fever

Signs / Symptoms?Sudden Onset of Severe Sore Throat, Fever,

Tender/Swollen Neck Glands, Exudate (pus) on Reddened Tonsils and Pharynx

Streptococcal Pharyngitis (Strep)Definition?Infection of the Posterior Pharynx and/or Tonsils

Common Cause?Group A Streptococcus bacteria

Patient’s Chief Complaint?Sore Throat, Fever

Signs / Symptoms?Sudden Onset of Severe Sore Throat, Fever,

Tender/Swollen Neck Glands, Exudate (pus) on Reddened Tonsils and Pharynx


Streptococcal Pharyngitis (Strep)

Referral to a Medical Officer?

Yes

Management?

Antibiotics (Penicillin)

Streptococcal Pharyngitis (Strep)

Referral to a Medical Officer?

Yes

Management?

Antibiotics (Penicillin)


Peri-tonsillar Abscess (PTA)Definition?

Bacterial infection of the tonsils.

Spreads into a cellulitis and abscess.

Common Cause?Complication of Strep

Chief Complaint?Severe Sore Throat, Pain/Difficulty Swallowing

Peri-tonsillar Abscess (PTA)Definition?

Bacterial infection of the tonsils.

Spreads into a cellulitis and abscess.

Common Cause?Complication of Strep

Chief Complaint?Severe Sore Throat, Pain/Difficulty Swallowing

Common Complaints of the Throat

Signs / Symptoms?Trismus*, Fever

(*difficulty opening the mouth)

Management?Surgical Drainage

Antibiotics

Referral?Immediate referral.

This is a surgical emergency

Signs / Symptoms?Trismus*, Fever

(*difficulty opening the mouth)

Management?Surgical Drainage

Antibiotics

Referral?Immediate referral.

This is a surgical emergency


Peri-tonsillar Abscess (PTA)

Usually affects one side

Mononucleosis (Mono)

Definition and Cause?

Viral infection

Chief Complaint?

Sore Throat, Fatigue

Signs / Symptoms?

Lymph Node Enlargement

Abdominal Pain

Mononucleosis (Mono)

Definition and Cause?

Viral infection

Chief Complaint?

Sore Throat, Fatigue

Signs / Symptoms?

Lymph Node Enlargement

Abdominal Pain


Infected Tonsils

Uvula

10 year old with massive tonsillar enlargement from Mono

Mononucleosis (Mono)Management?

Blood test (to confirm Mono)

Throat Culture (to rule out strep)

No contact sports/activity for a min. of 30 days

Treat the symptoms:

throat lozenges, acetaminophen, decongestants,

oral steroids

Referral?Yes

Mononucleosis (Mono)Management?

Blood test (to confirm Mono)

Throat Culture (to rule out strep)

No contact sports/activity for a min. of 30 days

Treat the symptoms:

throat lozenges, acetaminophen, decongestants,

oral steroids

Referral?Yes


Checking on your learning…Checking on your learning…

What are the RED FLAGSRED FLAGS of Throat Complaints?



Fever of 101 degrees F

Tonsillar Exudates

What are the RED FLAGSRED FLAGS of Throat Complaints?



Fever of 101 degrees F

Tonsillar Exudates

Checking on your learning…Checking on your learning…

Your patient complains of a sore throat and

difficulty swallowing.You complete a physical

exam of the patient and note he has a fever and see the following when you inspect his mouth.

What do you think the problem may be?

Would you refer this patient and why?

Your patient complains of a sore throat and

difficulty swallowing.You complete a physical

exam of the patient and note he has a fever and see the following when you inspect his mouth.

What do you think the problem may be?

Would you refer this patient and why? Yes – PTAs commonly require

surgical drainage and antibiotics

Peri-tonsillar Abscess (PTA)

SummarySummary

What are the RED FLAGSRED FLAGS of Ocular Complaints?

Loss of Vision


History of Trauma

Common Ocular Complaints?Red Eye

Conjunctivitis

What are the RED FLAGSRED FLAGS of Ocular Complaints?

Loss of Vision


History of Trauma

Common Ocular Complaints?Red Eye

Conjunctivitis

SummarySummary

What are the RED FLAGSRED FLAGS of Ear Complaints?



Common Ear Complaints?Cerumen Impaction

Otitis Externa (Swimmers’ Ear)

Otitis Media

What are the RED FLAGSRED FLAGS of Ear Complaints?



Common Ear Complaints?Cerumen Impaction

Otitis Externa (Swimmers’ Ear)

Otitis Media

SummarySummary

What are the RED FLAGSRED FLAGS of Sinus Complaints?


Common Nose and Sinus Complaints?Epistaxis

Allergies (Allergic Rhinitis or Hay Fever)

Acute Sinusitis

What are the RED FLAGSRED FLAGS of Sinus Complaints?


Common Nose and Sinus Complaints?Epistaxis

Allergies (Allergic Rhinitis or Hay Fever)

Acute Sinusitis

SummarySummary

What are the RED FLAGSRED FLAGS of Mouth Complaints?

Difficulty BreathingDifficulty Swallowing

Fever of 101 degrees F or greaterTonsillar Exudates

Common Complaints of the Mouth and Throat?

URI MonoStrep PTA

What are the RED FLAGSRED FLAGS of Mouth Complaints?

Difficulty BreathingDifficulty Swallowing

Fever of 101 degrees F or greaterTonsillar Exudates

Common Complaints of the Mouth and Throat?

URI MonoStrep PTA

Questions?Questions?Questions?Questions?

Education

Baseline Vitals and SAMPLE History